In China, color ultrasound screening of carotid arteries in patients with cerebral ischemic stroke or transient ischemic attack (TIA) found that 56.6% had significant atherosclerotic plaques, and the incidence of severe stenosis was as high as 12.5%, which confirmed the close relationship between patients with cerebral ischemia and extracranial carotid artery lesions in China. Carotid endarterectomy (commonly known as “dissection”) was first tried abroad in 1954 to treat extracranial carotid artery sclerosis occlusive disease and prevent cerebral infarction. This procedure simply involves surgically exposing the carotid artery, cutting through the stenotic segment of the carotid artery under direct vision, stripping away the sclerotic plaque, and then stitching up the carotid artery. It is important in the prevention and treatment of cerebral infarction because it not only restores the narrowed carotid artery diameter and increases cerebral blood flow, but also eliminates the source of microemboli. So, which patients are suitable for surgery? 1. Surgery is most effective for prevention when carotid stenosis is severe, reaching 70% to 99%. Initially, it was thought that symptomatic internal carotid artery stenosis, with stenosis of more than 75%, should be treated with carotid endarterectomy. Studies in the last decade have shown that, in addition to the above indications, carotid endarterectomy should be actively performed in patients with high-risk factors for cerebral infarction, with stenosis >50% in symptomatic patients and >60% in asymptomatic patients. 2.Patients with frequent episodes of TIA, except other factors should be actively prevented. 3.Patients who have had a stroke but recovered well, if they have carotid stenosis, within 3-4 years after the first attack, 20% to 45% will develop into complete stroke and should be treated actively. 4. Unstable plaque, i.e. uneven surface of plaque, uneven texture, or ulcer, bleeding inside the plaque should be highly alert. Of course, basic physical conditions should also be available. It should be reminded that for those whose carotid artery has been completely occluded or has developed irreversible severe stroke, surgery loses its significance. In the half century of development of carotid artery sclerosis occlusion surgery, it has gone through from the stage of routine surgery, simple balloon dilation, and stentoplasty. The procedure has been simplified, the time has been shortened, the risk of surgery has been reduced, and the indications for surgery have been expanded. However, the current medical market is mixed. We suggest that middle-aged and elderly people, if they show signs of TIA or cerebral infarction, go to a regular hospital in time to get a clear diagnosis and choose the appropriate treatment under the guidance of a doctor.